Fibromyalgia Testing Overview:
In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed. Our clinic does request some testing that is and not commonly performed in more "mainstream" medical clinics. 24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff. Some of these are discussed in detail in the links in this section.
What to Expect on Your First Visit:
First office visits typically last 45-60 minutes. Your doctor will review your intake form with you and gather a detailed medical history. A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors. Specialty laboratory testing may be recommended. Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.
First Visit: Blood Test
To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.
Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.
Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.
First Visit: Urine Analysis
To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.
A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.
Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.
First Visit: Resting ECG for Doctors Report
The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.
The doctor in charge reports any findings in his medical notes.
Specific Fibromyalgia Testing:
- Tender Points Test
What is the Tender Point Test?
The Tender Points Test sets the criteria to meet the diagnosis for Fibromyalgia. It checks on the 18 tender points in the body and presence of pain in the four quadrants (left and right side; above and below the waist) of the body.
Indications and Contraindications:
This test is used to help in the diagnosis of Fibromyalgia. It is performed by a specialist to patients who have widespread pain in the four quadrants of the body.
How do you prepare for the complete cholesterol testing?
There are no special preparations for the Tender Points Test.
How does it feel? How long will it take?
Pain and discomfort may be experienced while pressure is applied to the 18 tender sites.
Expected effects after the test:
Normally, there are no major effects after the test. In most cases, the patient may feel sore at the tender sites that are the most affected after the test.
Results:
Fibromyalgia may be diagnosed if the patient has widespread pain in the four quadrants of the body. Pain is felt at the 18 tender points when light pressure is applied.
The 18 tender points of the body are:
- Occiput: Bilateral, at the suboccipital muscle insertions.
- Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
- Trapezius: bilateral, at the midpoint of the upper border.
- Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
- Second rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces.
- Lateral epicondyle: bilateral, 2 cm distal to the epicondyles.
- Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
- Greater trochanter: bilateral, posterior to the trochanteric prominence.
- Knee: bilateral, at the medial fat pad proximal to the joint line.
Thyrotropin- Releasing Hormone (TRH) Stimulation Test
What is the Thyrotropin-Releasing Hormone Test?
The TRH Stimulation Test is a more sensitive thyroid test to detect a low thyroid that might have been missed by routine blood tests. It is a challenge test that evaluates how well ones pituitary and thyroid gland is functioning .By using the TRH stimulation test we frequently pick up the low thyroid missed by so many doctors
More and more doctors are realizing that routine thyroid blood tests, including TSH, T3 and T4, frequently do not pick up a low thyroid or hypothyroidism because they measure for disease in the thyroid. The TRH test is more likely to pick up a low thyroid because it measures the function of the thyroid. It can evaluate how well or how poorly your thyroid is functioning. And, because it is a stimulation test, it challenges the thyroid system and analyzes its response.
In a TRH test, a baseline TSH test is done. Then you are given an injection of TRH, which stimulates the pituitary to release TSH. A second blood sample is drawn 20 to 30 minutes later, and the TSH level is retested. TRH is known generically as protirelin (pronounced proe-TYE-re-lin)
Indications and Contraindications
The TRH Test evaluates patients who are suspected to be suffering from hyperthyroidism and hypothyroidism. It is also used for the differential diagnosis of Fibromyalgia.
The TRH test should be used with caution if the patient has the following conditions:
- Pregnancy
- Chronic obstructive pulmonary disease
- Asthma
- Hypopituitarism
- Heart disease
How do you prepare for the TRH Test?
There are no special preparations required for the TRH test. Inform your doctor of any OTC or prescription medications you are taking. You may be advised by your doctor to stop taking these drugs prior to your TRH test.
How does it feel? How long will it take?
A blood sample will be first collected prior to the administration of TRH. This it to check for the naturally occurring TSH levels in the blood. Then you are given an injection of TRH, which stimulates the pituitary to release TSH. A second blood sample is drawn 20 to 30 minutes later, and the TSH level is retested. The blood samples will be taken from a vein in your arm. An elastic band is wrapped around your upper arm and it may feel tight. You will feel nothing at all from the needle while your blood is being drawn or while the TRH is being injected, or you may feel a quick sting or pinch depending on your sensitivity to pain.
Expected effects after the test:
Normally, there are no major effects after the test. In some cases, patients may feel nauseous from the test. Patients may also feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may occur.
Special instructions after the test:
After drawing the blood, cover the needle site with a bandage and apply pressure on it for several minutes. If the site becomes swollen, do warm compresses few times a day. Report persisting pain, bleeding and swelling on the needle site. You may resume your regular diet and your daily activities after the test.
Results:
According to the American Association of Clinical Endocrinologists (AACE) guidelines, doctors have typically been basing their diagnoses on the normal range for the TSH test. The typical normal TSH levels at most laboratories, has fallen between the 0.3 to 3.04 range. Those with a TSH below .3 are considered to have too much thyroid hormone (hyperthyroid). Those whose test results are above 3.04 are considered to have too little thyroid (hypothyroid). However, it’s not uncommon to find doctors, including endocrinologists (thyroid specialist), who withhold the diagnoses and treatment of hypothyroid until a patient's TSH tests read considerably above 10. While some doctors believe that anyone who has a TSH above 2 and complains of hypothyroid symptoms (depression, fatigue, brain fog, etc.) should be placed on thyroid hormone
Notes:
- The new guidelines narrow the range for acceptable thyroid function; the AACE is now encouraging doctors to consider thyroid treatment for patients who test the target TSH level of 0.3 to 3.04, a far narrower range
- Routine Blood tests for thyroid function measure the amount of TSH, T4, and T3 in the bloodstream. But thyroid hormones don’t operate within the bloodstream; the action takes place in the cells themselves. Blood tests are measuring how much thyroid hormone is swimming around in the blood stream, but not what is in the cell. This is why the TRH test is so important.
- TRH is known generically as protirelin
The Right Diagnosis and Treatment for Fibromyalgia
Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.
Patients Medical’s Personal Approach to Fibromyalgia
Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.
We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.
Next Steps:
While you may find this medical information useful, as the next step we strongly recommend that you make an appointment to see one of our physicians to ensure that your health issues are properly addressed.
To schedule an appointment with our physicians, please call our patient coordinator at 1-212-679-9667, send the form below or an email to: info@patientsmedical.com. We are currently accepting new patients and look forward to being of assistance.
We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.
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Article Last Updated: 06/26/2009